Artificial Urinary Sphincter In Patients Research Articles

Prior male sling does not affect outcomes of artificial urinary sphincter.

To investigate the outcomes of artificial urinary sphincter (AUS) placement in patients with post-prostatectomy urinary incontinence (PPUI) with or without a prior male sling. We performed a retrospective chart review of patients who underwent AUS for PPUI from 2007 to 2022. The primary endpoint was to determine the proportion of patients who achieved social continence, defined as self-reported use of 0-1 pad/day. The secondary endpoints were device failure rates and device failure-free survival. The analysis included 210 patients, with 30 (14.3%) having had prior slings and 180 (85.7%) without prior slings. After AUS insertion, 80.0% of patients with prior slings and 76.7% of those without prior slings achieved continence (0-1 pad/day). There were six (20.0%) and 53 (29.4%) device failures in patients with and without prior slings, respectively. The median device failure-free survival was not reached in patients with prior slings and was 8.9 years in patients without prior slings (P = 0.048). Limitations include retrospective nature and small sample size. The efficacy and safety of AUS in patients with prior slings are similar to those without. Prior sling is associated with a longer device failure-free survival. AUS remains a viable option in patients who have persistent PPI after prior slings.

V07-02 URETHRAL BULKING WITH NATIVE TISSUE FOR FRAIL URETHRAS DURING ARTIFICIAL URINARY SPHINCTER SURGERY

You have accessJournal of UrologyCME1 Apr 2023V07-02 URETHRAL BULKING WITH NATIVE TISSUE FOR FRAIL URETHRAS DURING ARTIFICIAL URINARY SPHINCTER SURGERY William Du Comb, Nora Haney, Matthew Rabinowitz, James Liu, and Arthur Burnett William Du CombWilliam Du Comb More articles by this author , Nora HaneyNora Haney More articles by this author , Matthew RabinowitzMatthew Rabinowitz More articles by this author , James LiuJames Liu More articles by this author , and Arthur BurnettArthur Burnett More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003288.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The artificial urinary sphincter (AUS) has long been the ideal surgical treatment option for men with stress urinary incontinence (SUI) and has excellent patient satisfaction rates. However, revision rates remain as high as 50%. We describe our use of native periurethral tissue as a urethral bulking technique in patients with frail urethras during AUS surgery. METHODS: An AUS is inserted or revised in the usual standard fashion. The state of the urethral tissue is inspected, and the circumference is measured. When the urethral circumference is less than 4 cm or the urethral tissue is frail, periurethral tissue bulking is performed. Dissection of the bulbospongiosus muscle is carried out at the level of the bulbar urethra, incorporating it with a circumferential measurement. In the event the bulbospongiosus muscle is inadequate for bulking, the proximal corpus spongiosum is mobilized distally as a ventral flap, beneath the circumferential measurement. The AUS size is then selected. RESULTS: Using native periurethral tissue for urethral bulking can add up to 1 cm in cuff size when placing an AUS in patients with frail urethras. Patient satisfaction rates remain high, and there has been no documented device erosion with our technique. CONCLUSIONS: We have demonstrated an alternative approach to urethral bulking with native periurethral tissue in patients undergoing AUS placement who are found to have frail urethras. Urethral bulking with native tissue provides a durable alternative to transcorporal cuff placement or tandem cuffs to establish proper coaptation. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e596 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information William Du Comb More articles by this author Nora Haney More articles by this author Matthew Rabinowitz More articles by this author James Liu More articles by this author Arthur Burnett More articles by this author Expand All Advertisement PDF downloadLoading ...

Outcomes of Initial Transcorporal Versus Standard Placement of Artificial Urinary Sphincter in Patients With Prior Radiation.

Objective: This study aimed to evaluate both device and functional outcomes of men who underwent initial artificial urinary sphincter (AUS) placement after pelvic radiation using the transcorporal versus the standard approach.Methods: A retrospective review of patients who underwent first-time AUS placement after pelvic irradiation for prostate cancer was conducted between January 2008 and June 2020. Patients were grouped by transcorporal versus standard device placement. The primary outcomes of interest included major complications (revision or explant surgery) and functional outcomes (pads per day, International Prostate Symptom Score {IPSS}, quality of life {QOL} score).Results: We identified 45 patients who underwent first-time AUS with a history of prior pelvic irradiation for prostate cancer, 27 underwent transcorporal placement and 18 underwent standard placement. Transcorporal AUS placement resulted in a significantly lower number of major complications (p=0.01), explants (p=0.02), and revisions (p=0.04) The transcorporal artificial urinary sphincter group had better postoperative pads per day (p=0.04), IPSS (p<0.01), and IPSS QOL score (p<0.01).Conclusions: Initial transcorporal artificial urinary sphincter placement is a promising technique with lower rates of major complications in patients with a history of prior pelvic radiation and had better functional urinary outcomes.

Effectiveness of surgical management with an adjustable sling versus an artificial urinary sphincter in patients with severe urinary postprostatectomy incontinence: a systematic review and network meta-analysis.

Background:The purpose of this study was to determine the effectiveness of an adjustable sling compared with an artificial urinary sphincter (AUS) in patients with severe urinary incontinence (SUI) postprostatectomy (PP).Methods:This review was carried out following the Cochrane Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) declaration. We searched Medline, Embase, LILACS, and CENTRAL databases. Studies with patients older than 18 years of age with SUI PP who underwent sling or AUS intervention and had been monitored for longer than 12 months were included.Results:Seven studies were included, yielding a sample size of 420. Pads were reportedly dry or improved in 70% of the sling group compared with 74% in the AUS group. The Incontinence Impact Questionnaire, Short Form (IIQ-7) was the most frequently used scale and showed improvement, with a score of 82.8% in the AUS group compared with 86.1% in the sling group. When comparing interventions with nonintervention, relative risks (RRs) of 35.37 (95% confidence interval [CI]: 7.17–174.35) and 45.14 (95% CI: 11.09–183.70) were found for the adjustable sling and AUS, respectively, which were statistically significant. No significant differences were found when AUS versus adjustable sling were compared, with an RR of 0.78 (95% CI: 0.09–6.56). We found a low risk of bias in most studies.Conclusions:Both interventions can reduce incontinence and improve the quality of life of patients with SUI PP. The published literature is substantially limited as no randomized clinical trials are available, no consensus has been reached regarding the definition of severity of incontinence, and considerable heterogeneity exists across the outcome variables measured.

Prior Radiation Therapy Decreases Time to Idiopathic Erosion of Artificial Urinary Sphincter: A Multi-Institutional Analysis

Substantial controversy and conflicting data exist regarding the survival of the artificial urinary sphincter in patients with prior radiation therapy. We present data from a multi-institutional analysis examining the effect of prior radiation for prostate cancer on device survival. A database was compiled of patients with artificial urinary sphincter cuff erosion, which included demographic and comorbid patient characteristics, functional analyses and interventions. We identified 80 patients with iatrogenic or idiopathic artificial urinary sphincter erosion. Idiopathic erosion cases were further analyzed to determine factors influencing device survival with specific stratification for radiation therapy. A total of 56 patients were identified with idiopathic artificial urinary sphincter erosion. Of those men 33 (58.9%) had not undergone radiation treatment while 23 (41.1%) had a history of brachytherapy or external beam radiotherapy. In patients without radiation erosion-free median device survival was 3.15 years (95% CI 1.95-5.80), in contrast to the median device survival of only 1.00 year (95% CI 0.36-3.00) in irradiated patients. The erosion-free survival experience of patients with vs without radiation differed significantly (Wilcoxon-Breslow test for equality of survivor functions p = 0.03). Radiation therapy in patients with known idiopathic cuff erosion in this contemporary analysis correlated with significantly increased time to erosion. Mean time to idiopathic cuff erosion was accelerated by approximately 2 years in irradiated cases. To our knowledge these data represent the first demonstration of substantial outcome differences associated with radiation in patients with an artificial urinary sphincter who present specifically with cuff erosion.

Urethral atrophy after implantation of an artificial urinary sphincter: fact or fiction?

To investigate the concept of 'urethral atrophy', which is often cited as a cause of recurrent incontinence after initially successful implantation of an artificial urinary sphincter (AUS); and to investigate the specific cause of the malfunction of the AUS in these patients and address their management. Between January 2006 and May 2013, 50 consecutive patients (mean age 54.3 years) with recurrent incontinence had their AUS explored for malfunction and replaced with a new device with components of exactly the same size, unless there was a particular reason to use something different. Average time to replacement of the device was 10.1 years. The mean follow-up after replacement of the device was 24.7 months. All patients without an obvious cause for their recurrent incontinence had preoperative urodynamic evaluation, including measurement of the Valsalva leak point pressure (VLPP) and the retrograde cuff occlusion pressure (RCOP). After explantation of the AUS in patients without any apparent abnormality of the device at the time of replacement, the pressure generated by the explanted pressure-regulating balloon (PRB) was measured manometrically, when this was possible. In a select group of six consecutive patients of this type, the fibrous capsule surrounding the old cuff was incised then excised to expose and evaluate the underlying corpus spongiosum. In 31 of the 50 patients (62%) undergoing exploration, a specific cause for the malfunction of their AUS was defined. In the other 19 patients (38%) no cause was found, either preoperatively or at the time of exploration, other than a low VLPP and RCOP. A typical 'waisted' or 'hour-glass' appearance of the underlying corpus spongiosum was demonstrable, to some degree, on explanting the cuff in all cases. In the six patients in whom the restrictive sheath surrounding the cuff was excised, the urethral circumference immediately returned to normal after the compressive effect of the sheath was released. Manometry of the explanted PRBs, when this was possible, showed a loss of pressure in all instances. Replacement of the explanted AUS with a new device with the same size cuff and PRB in 14 of these 19 patients was successful in 12 (85.7%). These results, and other theoretical considerations, suggest that recurrent incontinence, years after initially successful implantation of an AUS, is because of material failure of the PRB, probably attributable to its age and consequent loss of its ability to generate the pressure it was designed to produce, and that urethral atrophy does not occur. Simply replacing the old device with a new one with the same characteristics, unless there is a particular reason to do otherwise, is usually successful and avoids the complications of alternatives such as as cuff downsizing, implanting a PRB with a higher pressure range, implantation of a second cuff or transcorporeal cuff placement, all of which have been advocated in these patients.

Comparing Argus sling and artificial urinary sphincter in patients with moderate post-prostatectomy incontinence.

Post-prostatectomy incontinence (PPI) is a main complication of radical prostatectomy. The purpose of this study was to compare the efficacy and safety of the Argus male sling (Argus) with that of artificial urinary sphincters (AUS) in patients with moderate PPI. A total of 33 moderate PPI patients underwent AUS or Argus implantation from January 2009 to June 2013 (13 AUS, 20 Argus). We defined moderate PPI as the use of 2–4 pads per day. To compare efficacy, we assessed the success rate between the two groups. Success was defined as the daily need for no pads or one small safety pad that remained dry most of the day. The mean patient age was 73.5±6.3 yr in the AUS group and 70.9±5.1 yr in the Argus group, and the mean follow-up period was 29.8±14.9 months in the AUS group and 24.7±11.8 months in the Argus group. The success rate was 72.7% in the AUS group and 85.0% in the Argus group (P=0.557). Abnormal postoperative pain persisted in more patients in the Argus group (6/20, 30%) than in the AUS group (1/13, 7.7%) (P=0.126). However, the rate of other complications was not different between the two groups (7.7% and 15.0% for AUS and Argus, respectively, P=0.822). Argus surgery showed similar success and complication rates to those of AUS in moderate PPI patients, indicating that it could be an alternative surgical option for the treatment of moderate PPI.

Impact of 3.5 cm Artificial Urinary Sphincter Cuff on Primary and Revision Surgery for Male Stress Urinary Incontinence

We report our initial clinical experience with the new 3.5 cm artificial urinary sphincter cuff. We reviewed the records of all men who underwent artificial urinary sphincter placement done by a single surgeon since September 2009. A perineal approach was used to ensure cuff placement around the most proximal corpus spongiosum after precise spongiosal measurement with a redesigned measuring tape. Clinical factors and cuff sizes were analyzed. During the 14-month study period 45 of 67 patients (67%) with an artificial urinary sphincter received the 3.5 cm cuff with no difference between primary and revision surgery (73% vs 58%, p = 0.29). Transcorporal cuff placement was reserved for 8 select patients (12%) after prior artificial urinary sphincter cuff erosion or complex urethroplasty. A tandem cuff artificial urinary sphincter was not used. Erectile dysfunction (89% vs 77%, p = 0.28) and prior radiation (47% vs 27%, p = 0.12) were more common in men who received a 3.5 vs a 4.0 cm or greater cuff. A similar proportion of men with a 3.5 cm vs a larger cuff (4 of 45 or 9% vs 2 of 22 or 9%) required explantation for infection and/or erosion. At our center the 3.5 cm cuff has become the predominant size used for primary and revision artificial urinary sphincter placement. Liberal use of the 3.5 cm cuff has simplified and improved artificial urinary sphincter placement without additional morbidity.

Implantation of Artificial Urinary Sphincter in Patients With Post-Prostatectomy Incontinence, and Preoperative Overactive Bladder and Mixed Symptoms

We assessed the impact of preoperative overactive bladder on the continence results of artificial urinary sphincter implantation, and describe the rates and risk factors associated with the development of de novo and persistent overactive bladder after artificial urinary sphincter surgery. A total of 129 consecutive patients treated with radical prostatectomy who had preoperative videourodynamics and virgin artificial urinary sphincter implantation were included in the study. During preoperative and postoperative visits patients were specifically queried about overactive bladder symptoms, anticholinergic medication use and continence status. The presence of concomitant overactive bladder symptoms before artificial urinary sphincter surgery did not negatively impact the overall continence results of the artificial urinary sphincter. De novo overactive bladder developed after artificial urinary sphincter surgery in up to a fourth (23%) of patients with pure stress incontinence (no overactive bladder). Most patients (71%) with preoperative mixed stress urinary incontinence plus overactive bladder symptoms continued to have persistent overactive bladder after artificial urinary sphincter surgery despite marked improvement of incontinence. Patients with a low preoperative cystometric capacity of 200 ml or less were more likely to have overactive bladder after artificial urinary sphincter surgery. Other clinical and urodynamic factors (eg the presence of detrusor overactivity) were not predictive. No risk factors predicted the development of de novo overactive bladder after artificial urinary sphincter surgery. The presence of preoperative overactive bladder does not adversely impact the overall continence results of the artificial urinary sphincter. Patients with mixed stress urinary incontinence plus overactive bladder symptoms preoperatively should not be denied the male incontinence surgery (artificial urinary sphincter) unless the overactive bladder symptoms are intractable. De novo and persistent overactive bladder occurs commonly after artificial urinary sphincter surgery. Thorough preoperative counseling is imperative to align patient expectations.

Editorial Comment on: The Artificial Urinary Sphincter in Patients with Spinal Cord Lesion: Description of a Modified Technique and Clinical Results

Editorial Comment on: The Artificial Urinary Sphincter in Patients with Spinal Cord Lesion: Description of a Modified Technique and Clinical Results

The Artificial Urinary Sphincter in Patients with Spinal Cord Lesion: Description of a Modified Technique and Clinical Results

BackgroundThe artificial sphincter is the method of choice in patients with stress urinary incontinence due to neurogenic bladder dysfunction. However, long-term studies reveal a high revision rate. ObjectiveTo determine the success and revision rates of a modified implant. Design, Setting, and ParticipantsIn a retrospective analysis, the results of 51 consecutive patients presenting at a private paraplegic center with neurogenic bladder dysfunction (meningomyelocele: n=8; spinal cord injury: n=37; others: n=6) who underwent implantation of an artificial sphincter at the bladder neck using a port instead of a pump were evaluated. MeasurementsSubjective and objective cure rates were assessed by video-urodynamics and a standardized interview. Results and LimitationsAfter a mean follow up of 95.9 mo, 70.6% of the patients were objectively and subjectively cured; 90.2% were completely continent in everyday life. Mean bladder capacity (465ml) and compliance (41.7ml/cm H2O) were normal. Sixteen patients underwent 18 revisions (35.3%). One implant had to be permanently removed. This is a single-centre study; thus, the results have to be confirmed. ConclusionsWith a long follow up of 8 yr, the modification presented by our group proved to be highly successful, reliable, safe, and even cost-effective. Therefore, it seems to be a valuable tool for the treatment of this group of patients.

Editorial Comment on: The Artificial Urinary Sphincter in Patients with Spinal Cord Lesion: Description of a Modified Technique and Clinical Results

Editorial Comment on: The Artificial Urinary Sphincter in Patients with Spinal Cord Lesion: Description of a Modified Technique and Clinical Results

Perineal Approach for Artificial Urinary Sphincter Implantation Appears to Control Male Stress Incontinence Better Than the Transscrotal Approach

Traditionally cuff placement of an artificial urinary sphincter is done through a perineal approach. A new approach through a penoscrotal incision or transscrotal approach is reportedly more rapid and easier than the traditional incision. These 2 approaches were evaluated to determine which one controlled male stress urinary incontinence better. We performed a retrospective chart review of 94 patients who underwent artificial urinary sphincter placement procedures from April 1987 to March 2004. A total of 126 artificial urinary sphincter cuffs (120 procedures, including double cuff placement in 6) were placed in 94 patients with 63 placed penoscrotally and 63 placed perineally. Of the double cuff placements 1 was perineal and 5 were transscrotal. In patients with a single initial or revision cuff the self-reported completely dry rate was 28.6% with the penoscrotal approach and 56.5% with the perineal approach (p = 0.01), while for initial cuffs only the dry rate was 28.0% and 56.7% for the penoscrotal and perineal approach, respectively (p = 0.03). Five of 28 patients (17.9%) with initial penoscrotal placement later underwent tandem cuff placement for continued incontinence, whereas only 1 of 32 (3.1%) with initial perineal placement later had a tandem cuff added (p = 0.06). There was no difference in the estimated failure-free survival (failure for any reason) of the device. When the artificial urinary sphincter cuff is placed through a perineal approach, there appears to be a higher completely dry rate and fewer subsequent tandem cuff additions than when the artificial urinary sphincter cuff is placed through a penoscrotal incision.

The Use of the Artificial Urinary Sphincter in the West of Scotland: a Single Centre 10-year Experience

The artificial urinary sphincter (AUS) has been used successfully to treat sphincter weakness incontinence in males over the past 30 years. Postoperative complications are well-recognised, but patient satisfaction remains high. We performed a retrospective single centre study of all patients who had an artificial urinary sphincter inserted over a 10-year period. We assessed patient satisfaction and continence post operatively as well as complication rate and need for revision or replacement surgery. Thirty-eight male patients (mean age 57 years) and 1 female patient had an AMS 800 (American Medical systems) AUS inserted between 1995 and 2005. Five (13%) patients have required replacement surgery to date. Male patients were divided into two groups according to the aetiology of their incontinence: neuropathic (n = 11) and non-neuropathic (n = 27). Social continence was achieved in all patients. Three (11%) non-neuropathic patients developed complications. Revision surgery was undertaken in 4 (15%) of non-neuropathic patients and in 1 (9%) neuropathic patient. The mean lifespan of the AUS in patients who required further surgery is 6.6 years. For patients with severe sphincter weakness incontinence the AMS 800 AUS is a safe and reliable solution. Our results are comparable with previous published studies of larger patient numbers from dedicated reconstructive units.

14 Years of Experience With the Artificial Urinary Sphincter in Children and Adolescents Without Spina Bifida

The efficacy of the artificial urinary sphincter to treat sphincteric incontinence in pediatric patients with spina bifida has been clearly reported. The possibility of maintaining spontaneous voiding has usually been the main reason for prosthetic device surgery. We reviewed our experience with the artificial urinary sphincter in patients without spina bifida who had had previous surgery of the bladder neck or proximal urethra. From 1990 to 2004, 112 children and adolescents underwent implantation of an AMS 800 artificial urinary sphincter. Of the patients 19 males and 4 females (20.5%) between ages 4 and 17 years (mean 8.1) had no spina bifida. Instead there were bladder exstrophy in 12 patients, anorectal malformation with a rectourethral or vesical fistula in 7 and epispadias in 4. A bladder neck cuff between 5.5 and 7.5 cm, and a 61-70 balloon were used in all patients. Only 1 patient was lost to followup. In 22 patients (95.6%) mean followup was 80 months (range 4 to 155). Three sphincters in patients with exstrophy were removed because of erosion and/or infection 5, 49 and 60 months after initial surgery, respectively. A total of 19 sphincters remained in place (86.3% survival rate) with 5 revisions (26.3%) because of the pump (2), the cuff (2) or balloon fluid leakage. In this group 13 patients (68.4%) voided spontaneously and 6 (31.6%) performed clean intermittent catheterization, although 3 also voided spontaneously. Overall continence was good in 87% of patients because 2 were still incontinent at night. The artificial urinary sphincter is a good long-term solution to urinary incontinence secondary to sphincter incompetence despite multiple previous surgeries of the bladder neck or proximal urethra. Patients with bladder exstrophy and many previous bladder procedures are more exposed to complications such as erosion compared with patients with epispadias or anorectal malformation. The high percent of patients maintaining spontaneous voiding and the good rate of continence are the most important benefits of this type of surgical option for sphincter incompetence.

Is the Bladder a Reliable Witness for Predicting Detrusor Overactivity?

We determined how well the symptoms of OAB syndrome correlate with urodynamic DO using International Continence Society definitions. The study included adult males and females 18 years or older who attended a tertiary referral center for urodynamics from February 2002 to February 2004. Patients were selected based on OAB syndrome symptoms (urgency, urgency urinary incontinence and frequency). The percent of patients who had symptoms alone or in combination and DO was calculated. There was a better correlation in results between OAB symptoms and the urodynamic diagnosis of DO in men than in women. Of men 69% and 44% of women with urgency (OAB dry) had DO, while 90% of men and 58% of women with urgency and urgency urinary incontinence (OAB wet) had DO. Stress urinary incontinence seems to have accounted for the decreased rates in women since 87% of women with urgency urinary incontinence also had the symptom of stress urinary incontinence. The ICS definition does not specify what constitutes abnormal voiding frequency. Analysis of results showed that increasing voiding frequency did not have any effect on increasing the accuracy of diagnosis of DO except in women with 10 or more daytime micturition episodes. The bladder is a better and more reliable witness in men than in women with a greater correlation between OAB symptoms and urodynamic DO, more so in the OAB wet than in OAB dry patients.

490: Outcome of Artificial Urinary Sphincter in Patients with Concomitant Postprostatectomy Incontinence and Bladder Neck Contracture

You have accessJournal of UrologyPodium, Sunday, May 9, 2004, 10:00 am - 12:00 pm1 Apr 2004490: Outcome of Artificial Urinary Sphincter in Patients with Concomitant Postprostatectomy Incontinence and Bladder Neck Contracture Mohamed A. Gomha, and Timothy B. Boone Mohamed A. GomhaMohamed A. Gomha More articles by this author , and Timothy B. BooneTimothy B. Boone More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)37752-8AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "490: Outcome of Artificial Urinary Sphincter in Patients with Concomitant Postprostatectomy Incontinence and Bladder Neck Contracture." The Journal of Urology, 171(4S), p. 131 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 171Issue 4SApril 2004Page: 131 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Mohamed A. Gomha More articles by this author Timothy B. Boone More articles by this author Expand All Advertisement Loading ...

Quality of Life, Functional Outcome and Durability of the AMS 800 Artificial Urinary Sphincter in Patients with Intrinsic Sphincter Deficiency

Objective: To evaluate the quality of life, functional outcome and durability of the AMS 800 artificial urinary sphincter (AUS) in patients with urinary incontinence due to intrinsic sphincter deficiency of mixed origin. Patients and Methods: Between 1991 and 2000, 34 AUS were implanted in 31 patients (24 males/7 females) with mean age of 59 (range 15–75) years. Using a questionnaire, patients’ urinary function and quality of life were assessed in 22 patients with an AUS in situ. To evaluate efficacy and durability of the device, the primary adequate function (P-AF) and additional procedure-assisted adequate function (APA-AF) rates were determined on the basis of a Kaplan-Meier survival analysis. Results: The social continence rate (0–1 pads/24 h) was 55% with a mean follow-up of 46 months. The revision rate was 26% and the explantation rate 35%. The 5-year P-AF and APA-AF rates were 41 and 44%, respectively. The pad score decreased from 2.95 to 1.23 after AUS implantation (p < 0.0001) leading to a high mean patient satisfaction (rated as 4.0 on a visual analog scale of 0–5). Twenty-one patients (95%) would undergo the procedure again under the same circumstances. Patients with previous anti-incontinence procedures showed a significantly higher explantation rate (p = 0.004). Conclusion: In spite of a relatively high re-operation rate and moderate social continence state, patient satisfaction was found to be great mainly due to the relative improvement in incontinence. The AMS 800 AUS is a reliable device with few mechanical complications. Extensive preoperative counseling is mandatory.

REVISION RATE AFTER ARTIFICIAL URINARY SPHINCTER IMPLANTATION FOR INCONTINENCE AFTER RADICAL PROSTATECTOMY: ACTUARIAL ANALYSIS

We determined the actuarial revision rate for artificial urinary sphincters implanted in patients who were incontinent after radical prostatectomy. We reviewed the records of 70 consecutive patients who were incontinent after radical prostatectomy and who underwent primary artificial urinary sphincter implantation at the University of Michigan between 1984 and 1999. Questionnaires were mailed to all patients with an indwelling device, and telephone calls were placed to those who did not respond to the mailing. Information about surgical revision and current continence status was obtained from chart review and questionnaire response. The Kaplan-Meier curves for actuarial freedom from operative revision were constructed. Of the 66 patients with available postoperative data 24 (36%) required reoperation at a mean followup of 41 months. The 5-year actuarial rate for freedom from any operative revision was 50%, and the corresponding rate for cuff revision was 60%. A single operative revision did not predispose the patient to further revision. Questionnaire data indicated a continence rate of 80% (range 0 to 2 pads). Approximately half of the patients who were incontinent after radical prostatectomy may expect to undergo operative revision within 5 years after artificial urinary sphincter implantation. Despite this high reoperation rate, an excellent level of continence is maintained.

THE LONG-TERM OUTCOME OF ARTIFICIAL URINARY SPHINCTERS

THE LONG-TERM OUTCOME OF ARTIFICIAL URINARY SPHINCTERS